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Original article
Long-term outcomes and risk factors for aortic regurgitation after discrete subvalvular aortic stenosis resection in children
  1. Sarah S Pickard1,2,
  2. Alon Geva3,4,
  3. Kimberlee Gauvreau1,2,
  4. Pedro J del Nido5,6,
  5. Tal Geva1,2
  1. 1Departments of Cardiology, Boston Children's Hospital, Boston, Massachusetts, USA
  2. 2Departments of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
  3. 3Critical Care Medicine, Boston Children's Hospital, Boston, Massachusetts, USA
  4. 4Department of Anesthesia, Harvard Medical School, Boston, Massachusetts, USA
  5. 5Cardiovascular Surgery, Boston Children's Hospital, Boston, Massachusetts, USA
  6. 6Department of Surgery, Harvard Medical School, Boston, Massachusetts, USA
  1. Correspondence to Dr Tal Geva, Department of Cardiology, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA 02115, USA; tal.geva{at}cardio.chboston.org

Abstract

Objectives To characterise long-term outcomes after discrete subaortic stenosis (DSS) resection and to identify risk factors for reoperation and aortic regurgitation (AR) requiring repair or replacement.

Methods All patients who underwent DSS resection between 1984 and 2009 at our institution with at least 36 months’ follow-up were included. Demographic, surgical and echocardiographic data were reviewed. Outcomes were reoperation for recurrent DSS, surgery for AR, death and morbidities, including heart transplant, endocarditis and complete heart block.

Results Median length of postoperative follow-up was 10.9 years (3–27.2 years). Reoperation occurred in 32 patients (21%) and plateaued 10 years after initial resection. Survival at 10 years and 20 years was 98.6% and 86.3%, respectively. Aortic valve (AoV) repair or replacement for predominant AR occurred in 31 patients (20%) during or after DSS resection. By multivariable analysis, prior aortic stenosis (AS) intervention (HR 22.4, p<0.001) was strongly associated with AoV repair or replacement. Risk factors for reoperation by multivariable analysis included younger age at resection (HR 1.24, p=0.003), preoperative gradient ≥60 mm Hg (HR 2.23, p=0.04), peeling of membrane off AoV or mitral valve (HR 2.52, p=0.01), distance of membrane to AoV <7.0 mm (HR 4.03, p=0.03) and AS (HR 2.58, p=0.01).

Conclusions In this cohort, the incidence of reoperations after initial DSS resection plateaued after 10 years. Despite a significant rate of reoperation, overall survival was good. Concomitant congenital AS and its associated interventions significantly increased the risk of AR requiring surgical intervention.

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